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CRB CASE NOTES SHEET Review Date: Date of Last Review:

|MOTHER: | | | |

|Child: |Age: |Father: |Status: |

|Child: |Age: |Father: |Status: |

|Child: |Age: |Father: |Status: |

|Child: |Age: |Father: |Status: |

|Child: |Age: |Father: |Status: |

|Child: |Age: |Father: |Status: |

|Attorney for Child: |Caseworker: |

|Attorney for Mother: |CASA: |

|Attorney for Father: |Other: |

|Case Summary (optional): |

|Please confirm the following: |Been in care since ( months) |

|Voluntary Custody/Placement (y/n): |Plan: |

|Date of Jurisdiction: |Concurrent Plan: |

|Basis of Jurisdiction |

|Mother: |

|Father: |

|ICWA Status of Mother: |__ Signed 1270 Form |

|ICWA Status of Father(s): |__ Signed 1270 Form |

| |__ Signed 1270 Form |

|We will now address placement efforts. |

|Has DHS made __reasonable __active efforts to prevent or eliminate the need for removal of the child from the home? (First review only. Active |

|efforts standard if ICWA applies.) |

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|Has DHS made diligent efforts to place the child with a relative or person who has a caregiver relationship? (Applies in all cases.) |

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|We will now address services to the child. |

|3A. Has DHS ensured that appropriate services are in place to safeguard the child’s safety, health and well-being? (Applies in all cases.) |

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|3B. Has DHS taken appropriate steps to ensure that 1) the substitute care provider is following the reasonable and prudent parent standard, and 2) the|

|child has regular, ongoing opportunities to engage in age appropriate or developmentally appropriate activities? |

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|We will now address efforts the agency has made toward the permanency plan. |

|Has DHS made __reasonable __active efforts to provide services to make it possible for the child to safely return home? (Applies only if plan is|

|“Return to Parent.” Active efforts if ICWA.) |

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|Has DHS made reasonable efforts in accordance with the case plan to place the child in a timely manner, and to complete the steps necessary to |

|finalize the permanent placement, including an interstate placement if appropriate? (Applies only if the plan is NOT “Return to Parent.”) |

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|We will now address progress and compliance issues. |

|Have the parents have made sufficient progress to make it possible for the child to safely return home? |

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|Has DHS has made sufficient efforts in developing the concurrent permanency plan? (Applies only when the plan is return to parent.) |

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|Is DHS in compliance with the case plan and court orders? (Applies in all cases) |

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|Recommendations from last CRB Review: |

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|We will now address the appropriateness of the plan. |

|Is the permanency plan the most appropriate for the child? (Applies in all cases.) |

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|Is there a continuing need for placement? (Applies in all cases.) |

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|Estimated date to leave care: |

Additional finding(s)

a. The next review due date is:

b. The date of the next permanency hearing is: (*NOTE: A permanency hearing is required if the child has been legally free for 6 months and is still not placed for adoption.)

c. Is a recommendation to reschedule the permanency hearing to an earlier date needed to prevent a duplicative review?

d. Did the agency implement the Board’s previous recommendations or reply within 17 days of receipt that they did not intend to do so?

RECOMMENDATIONS

Plan:

Placement:

Services to Parents:

Services to Children:

Parental Involvement in Services:

Visits:

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